Individual provider Active NPI

Rhonda Keen Bray, O.D.

  • Optometrist
  • Bowling Green, KY
National Provider Identifier
1285623512
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1371DT Issued in KY
Practice address
1639 Westpark Dr
Bowling Green, KY 42104-4712
Phone
(270) 796-6021
Fax
(270) 796-6072
NPI assigned
Oct 19, 2005
Last updated
Mar 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1371DT KY Primary

Addresses

Primary practice location

1639 Westpark Dr
Bowling Green, KY 42104-4712

Mailing address

1639 Westpark Dr
Bowling Green, KY 42104-4712
Phone (270) 796-6021

Other identifiers 1

IdentifierTypeStateIssuer
77013712MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060427000003 KY Practitioner - Optometry 4688684269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Love and Warden Eye Care, PLLCGroup PAC ID 8224007380, 3 clinicians

Practice addresses (Care Compare)

1639 Westpark Dr
Bowling Green, KY 42104-4712
Phone (270) 796-6021

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1371DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Love and Warden Eye Care, PLLC Optometrist CurrentSince May 13, 2022 Accepting new patients

Locations

1639 Westpark Dr
Bowling Green, KY 42104
Phone (270) 796-6021

1945 Scottsville Rd
Ste B2
Bowling Green, KY 42104
Phone (270) 781-4828

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1285623512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1639 WESTPARK DR",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421044712",
            "telephone_number": "270-796-6021",
            "fax_number": "270-796-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 WESTPARK DR",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421044712",
            "telephone_number": "270-796-6021",
            "fax_number": "270-796-6072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAY",
        "first_name": "RHONDA",
        "middle_name": "KEEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-19",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1371DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77013712",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.